Dealing with depression

Lynn Rossy has been a clinical psychologist at MU since 1999. Every year, she sees more and more students with the tell-tale signs of clinical depression — feelings of hopelessness, a serious lack of motivation, poor eating habits and dwindling interest in being with friends.

While Rossy said the number of mental health professionals at the Student Health Center has tripled since she’s been here, it hasn’t been enough to curb a crisis that afflicts college campuses across the country. “We get busier and busier each year,” Rossy said. “We are all overwhelmed and inundated and cannot meet the demand.”

The number of MU students seeking mental health services at the Student Health Center increased 14 percent from 2004 to 2005, said Susan Even, MU’s director of student health; and that doesn’t include students who report feeling anxious and depressed to the center’s general practitioners.

In July, the American College Health Association reported that, based on interviews conducted on campuses around the country, 46 percent of American college students had felt, on at least one occasion, so depressed that it was difficult to function and 64 percent said they felt hopeless one or more times. Some universities have responded by forcing students who have attempted suicide or are believed to be a threat to themselves to take a medical leave from school. Even said MU is developing some local guidelines for how to respond to the needs of suicidal students.

The reasons for the increasing demand for mental health services on college campuses are varied and usually involve a combination of hereditary and environmental factors. Students seem to be under more pressure than in the past, Rossy said. Many have to work full or part time to help pay for their education as the cost of attending college rises. The stress of holding down a job while maintaining an acceptable grade-point average can be overwhelming.

“The lifestyle that they try to maintain places too many demands,” Rossy said. “They are not getting enough sleep, not eating well, always out of time.”

Even agreed that the increase in students who have to work contributes to higher rates of depression and anxiety. Changes in “family dynamics, more students from families where parents have been divorced, remarried” can create additional stress as well, she said. Even also cited a factor that could be considered more positive: better diagnostic capabilities, which means more students are getting treatment for mental illness in grade school and high school. While this helps them control their depression once they arrive on campus, they still require regular mental-health services.

Terry Wilson, coordinator of health promotion at MU, said the abrupt change in lifestyle experienced by first-time college students can be a major source of stress and anxiety. “They may feel fear of a new territory, in a situation where a lot of change is going on,” Wilson said. “They may be very insecure in how they identify themselves, because as a senior in high school their self image was fairly solid. Now they are entering a new and competitive environment.”

Brenda McSherry, director of health services at Stephens College, said she watched all of these factors converge over the years. “This is my seventh year here,” she said. “As soon as I got here I was seeing a challenge in the mental health area. This has been talked about in colleges for the last ten years.”

McSherry and Terri Zeilenga, director of counseling services at Columbia College, said their schools aren’t nearly as overwhelmed by the demand for mental health services as MU. McSherry said the most distressed students can see a counselor or physician the same day; others wait no longer than a week for an appointment. Zeilenga says the mental-health staff at Columbia College is a “one-man show, just me.” The school offers students up to eight counseling sessions, and a nurse practitioner is available to prescribe medications in certain cases and or refer students to physicians and psychiatrists in the community.

At MU, Even is much less optimistic. She is bracing for another increase in students seeking treatment and is worried about the additional demand on a service that is already understaffed and lacking space. Indeed, according to the International Association for Counseling Services, university counseling centers should have one psychologist per 1,500 students. Jenny Lybeck-Brown, a psychologist with the MU Counseling Center, said that MU’s ratio is one for every 2,451 students.

“We could use a lot more help, but we only have so much money,” Even said.

Funding for most student health services comes primarily from student fees, which are currently about $79 per semester. That covers about 83 percent of the center’s expenses. However, the fee for counseling-center services is only $3.50. This makes up only 0.15 percent of the center’s total $1.1 million annual budget.

The majority of the budget comes from a general allocation by the university. Even said that any additional student health fees approved by the Board of Curators would likely be used for more counseling services. However, students have been reluctant to approve anything that would add to the already high cost of education. Last year, when Even requested a nine percent increase in the student health fee, the Student Fee Review Committee suggested that the center instead begin charging for more procedures and lab services in order to generate revenue to increase mental health services.

More funding could help the center fill one of its biggest needs: a nurse practitioner with training in mental health. Even said a nurse practitioner could do crisis assessment by identifying the neediest students and linking them up with available resources, even in cases where they lack funding.

A nurse practitioner could also handle case management for students who have multiple health problems, helping them balance those needs and reminding them of upcoming appointments. The health center also needs more psychologists, Even said, and has an unfilled supervisor position.

She also said an adequately funded health-care system for students is important for another reason. The shortage of resources is forcing her staff to refer students with private health insurance to practitioners in the community. But she fears that may actually mean fewer students are getting help.

“Many students do not want to have to file an insurance claim every time they come in or don’t want to go to their parents and say that they need mental health treatment,” she said.